The Effect of Fasting Ramadan on Diabetic Patients with High Risk of Cardiovascular Disease

One of the common questions for patients with a history of cardiovascular disease is whether it is safe for them to fast during Ramadan. Yet, studies on the effects of Ramadan fasting on blood lipids, blood pressure, anthropometric parameters and other cardiovascular risk factors are scarce, and have given inconclusive results. The aim of this study is to investigate the effect of Ramadan fasting on cardiovascular risk factors including biochemical indices, blood pressure and main anthropometric parameters. This Prospective observational study was conducted at the CCU (Coronary care unit) and medical wards of Madinat Zayed hospital one of Al Dhafra hospitals, under Seha Abu Dhabi. Fifty-Six diabetic patients admitted with cardiovascular events including 48 males and 8 females with a previous history of cardiovascular event completed the study. Their age ranged between 32 and 91 years with a mean of 54.0 ± 10 years. A non-significant slight biochemical modification with regard to the metabolic profile pre, during and post-Ramadan period was reported: eGFR, total cholesterol, LDL, and HDL were increased yet, triglycerides and creatinine were non-significantly lower during Ramadan. Findings also showed a non-significant decrease in the post Ramadan blood pressure values which could be attributed to the metabolic switch.

Consolidation chemoradiation (cCTRT) improves survival in responders to first?line chemotherapy (CT) in locally advanced gallbladder cancer (LA?GBC): A new standard of Care?

Introduction: Chemotherapy (CT) is the standard of care in advanced gallbladder cancer (GBC). Should locally advanced GBC (LA-GBC) with response to CT and good performance status (PS) be offered as consolidation chemoradiation (cCTRT) to delay progression and improve survival? There is a scarcity of literature on this approach in the English literature. We present our experience with this approach in LA-GBC. Materials and Methods: After obtaining ethics approval, we reviewed the records of consecutive GBC patients from 2014 to 2016. Out of 550 patients, 145 were LA-GBC who were initiated on chemotherapy. A contrast-enhanced computed tomography (CECT) abdomen was done to evaluate the response to treatment, according to the RECIST (Response Evaluation Criteria in Solid Tumors) criteria. All responders to CT (PR and SD) with good PS but unresectable were treated with cCTRT. Radiotherapy was given to GB bed, periportal, common hepatic, coeliac, superior mesenteric, and para-aortic lymph nodes up to a dose of 45 to 54 Gy in 25 to 28 fractions along with concurrent capecitabine at the rate of 1,250 mg/m2. Treatment toxicity, overall survival (OS), and factors affecting OS were computed based on Kaplan–Meier and Cox regression analysis. Results: The median age of patients was 50 years (interquartile range [IQR] = 43–56 years), and men to women ratio was 1:3. A total of 65% and 35% patients received CT and CT followed by cCTRT, respectively. The incidence of Grade 3 gastritis and diarrhea was 10% and 5%, respectively. Responses were partial response (PR; 65%), stable disease (SD; 12%), progressive disease (PD; 10%), and nonevaluable (NE; 13%) because they did not complete six cycles of CT or were lost to follow-up. Among PR, 10 patients underwent radical surgery (six after CT and four after cCTRT). At a median follow-up of 8 months, the median OS was 7 months with CT and 14 months with cCTRT (P = 0.04). The median OS was 57 months, 12 months, 7 months, and 5 months for complete response (CR) (resected), PR/SD, PD, and NE (P = 0.008), respectively. OS was 10 months and 5 months for Karnofsky performance status (KPS) >80 and <80 (P = 0.008), respectively. PS (hazard ratio [HR] = 0.5), stage (HR = 0.41), and response to treatment (HR = 0.05) were retained as independent prognostic factors.

Exploring the role and lived experiences of people with disabilities working in the agricultural sector in northern Nigeria

It is estimated that over 75.0% of households in sub-Saharan Africa are involved in agriculture, and the majority of the poor in rural areas rely on agriculture for their livelihoods. One billion people living with disabilities in low- and middle-income countries are argued to make up the poorest of the poor, yet to our knowledge, no literature has captured the livelihood of people living with disabilities in the context of farming in Nigeria, specifically northern Nigeria where most of the households are involved in agriculture and related activities. Objectives: This article reports on findings from a study that sought to understand disability in the context of northern Nigerian farming, with a particular focus on the role and lived experiences of people living with disabilities working in the agricultural sector. Method: A survey questionnaire was developed and captured the experiences of 1067 people living with disabilities working in the agricultural sector across five states (Adamawa, Bauchi, Jigawa, Kaduna and Yobe) in northern Nigeria. Results: Findings indicate that people with disabilities are actively participating in agricultural activities for several reasons, which specifically included 'forced to and for survival'. When participants reported needing care, this was predominantly provided by family members. Findings also showed that participants with disabilities experienced several economic and sociocultural challenges because of their impairments. Conclusion: This study adds to the very limited literature on farmers living with disabilities in sub-Saharan Africa and so highlights the need for more research to be conducted with farmers living with disabilities in Nigeria, particularly female farmers living with disabilities. These will provide more evidence pertaining to the experiences of farmers living with disabilities in order to provide effective disability- and gender-inclusive agricultural and entrepreneurship programs in Nigeria. Contribution: The results of this research reveal important insights relating to the experiences of farmers living with disabilities in northern Nigeria, which can contribute to informing future developmental projects to achieve effective inclusion and actively benefit people living with disabilities.

Exploring the role and lived experiences of people with disabilities working in the agricultural sector in northern Nigeria

It is estimated that over 75.0% of households in sub-Saharan Africa are involved in agriculture, and the majority of the poor in rural areas rely on agriculture for their livelihoods. One billion people living with disabilities in low- and middle-income countries are argued to make up the poorest of the poor, yet to our knowledge, no literature has captured the livelihood of people living with disabilities in the context of farming in Nigeria, specifically northern Nigeria where most of the households are involved in agriculture and related activities. Objectives: This article reports on findings from a study that sought to understand disability in the context of northern Nigerian farming, with a particular focus on the role and lived experiences of people living with disabilities working in the agricultural sector. Method: A survey questionnaire was developed and captured the experiences of 1067 people living with disabilities working in the agricultural sector across five states (Adamawa, Bauchi, Jigawa, Kaduna and Yobe) in northern Nigeria. Results: Findings indicate that people with disabilities are actively participating in agricultural activities for several reasons, which specifically included 'forced to and for survival'. When participants reported needing care, this was predominantly provided by family members. Findings also showed that participants with disabilities experienced several economic and sociocultural challenges because of their impairments. Conclusion: This study adds to the very limited literature on farmers living with disabilities in sub-Saharan Africa and so highlights the need for more research to be conducted with farmers living with disabilities in Nigeria, particularly female farmers living with disabilities. These will provide more evidence pertaining to the experiences of farmers living with disabilities in order to provide effective disability- and gender-inclusive agricultural and entrepreneurship programmes in Nigeria. Contribution: The results of this research reveal important insights relating to the experiences of farmers living with disabilities in northern Nigeria, which can contribute to informing future developmental projects to achieve effective inclusion and actively benefit people living with disabilities

The Effects of Corona Virus (COVID-19) Outbreak on the Individuals’ Mental Health and on the Decision Makers: A Comparative Epidemiological Study

Background: The results of epidemiological studies help in developing protective and treatment plans for community members, and identifying the psychological support services that individuals need to reduce the negative effects of these stressful conditions. Therefore, this study aimed to detect the effect of the outbreak of the deadly COVID-19 on the mental health of individuals. A survey descriptive design was used in this study to detect the level of psychological problems and to determine the differences in psychological problems due to nationality, age, sex, social status, learning level, and income. Method: A random sample consists of 5611(3423 Egyptians and 2188 Saudis) participants was chosen, their ages ranged between (16 to more than 50) year. The study sample was divided into sub-groups according to nationality, age, sex, social status, learning level, income level. The researchers in this study prepared psychological problems symptoms inventory that has been applied online to the sample. Results: The findings indicated that the increased prevalence of COVID -19 has a negative effect on the mental health of individuals, as the level of psychological problems were increased, and the results also found differences in the prevalence of psychological problems symptoms due to demographic variables. Conclusion: The study results emphasized the importance of prevention and treatment of psychological problems symptoms caused by the outbreak of the deadly COVID-19. As well as, these findings stressed on the role of counseling and therapy via the internet as well as, cross-cultural counseling and treatment.

Palestinian emergency nurses’ knowledge and role perception about disaster management: a need for immediate actions

Background: Preventing, preparing for, responding to, and recovering from disasters have become a priority for everyone. Gaza Strip in Palestine is constantly exposed to wars and disasters. One of the most prominent respondents to disasters in the health care system is emergency nurses. This study aimed to identify the role perception of Palestinian emergency nurses in Gaza Strip during disaster and their level of knowledge about disaster management.Methods: The analytical descriptive cross-sectional approach was used. The study sample consisted of all nurses working in emergency departments at the governmental hospitals in Gaza Strip. The eligible nurses were 180; only 162 filled the questionnaire with response rate 90% after signing the consent form. Data were analyzed using mean, t test and ANOVA.Results: The findings indicated that 75.9% of emergency nurses were male. About 53% were 20-29 years old. Most of them hold bachelor degree (73.5%) while only 4.3% had a master degree. The study found that the level of “role perception of nurses during disasters” was 81.5% (e.g., ability to participate in an emergency plan, provide psychosocial support, have high confidence during emergencies, etc.), followed by field of “nurses’ knowledge of disasters” with 78.03% (e.g., past experience, updated information, etc.).Conclusions: Although the Palestinian emergency nurses have an acceptable level of knowledge and role perception during disasters, they still need to raise their level of knowledge, preparedness and skills by integrating clearly defined theoretical and training sessions on disaster management in nursing curricula and through in-service activities for employees.

Knowledge, attitude, and practices towards diabetes mellitus among non-diabetes community members of Riyadh, Kingdom of Saudi Arabia

Background: The Kingdom of Saudi Arabia is in the midst of a diabetes mellitus (DM) epidemic whose originscan be traced to (a) the widespread adoption of the Western diet that is high in sugar, (b) an increase in sedentaryactivity, and (c) ignorance of the importance of DM. The purpose of this cross-sectional study was to quantifyvarious aspects of (a) knowledge, (b) attitudes, and (c) practice relating to DM. Methods: The three researchquestions addressed in this study were: (1) Is there any significant relationship between attitudes to DM andpractices related to DM? (2) Is there any significant relationship between knowledge of DM and practices relatedto DM? (3) Is there any significant relationship between knowledge of DM and attitudes to DM? Separate surveysfor each question collected data from a representative sample of 1,067 adult both male and female Saudis fromRiyadh who have not been diagnosed with DM. Results: Data analysis of the data from the study indicated thatfor each of the three research questions, the null hypothesis could not be rejected, indicating that none of therelationships were statistically significant. Conclusion: The absence of significance for each of the findings hasimportant implications, including (a) the possibility that many Saudis incorrectly believe themselves to beunsusceptible to DM and (b) the high prevalence of DM-causing behaviors in the Saudi population. These twoimplications should be of particular concern to public health authorities and health educators in Saudi Arabia,who may need to work more diligently to educate non-DM-diagnosed Saudis on their vulnerability to DM

Protective effect of Nigella sativa against paracetamol induced hepatic and renal damages.

Background: Non-steroidal anti-inflammatory drugs are very commonly used as an analgesic, antipyretic, anti-inflammatory, and antiplatelet agent. They have significant adverse effect on liver and kidney besides damaging stomach. Their effect on liver and kidney are of serious concern. Hence, we have decided to study the preventive effect of Nigella sativa against paracetamol induced hepatic and renal damages. Methods: Ethanolic and aqueous extracts of N. sativa were prepared with the help of Soxhlet’s apparatus. Totally, 36 wistar albino rats (150-200 g) of either sex were divided into six groups of six each. Group I was administered with distilled water, Group II-VI were treated with paracetamol 750 mg/kg i.p. Group III-VI were test groups also treated with N. sativa aqueous extract (200 and 400 mg/kg p.o) and ethanolic extract (200 and 400 mg/kg p.o), respectively. The treatment was given daily for 7 days and on 8th all the rats were sacrificed and the blood was analyzed for hepatic and renal function tests and tissue was preserved for histopathological examination. Results: Paracetamol administration caused a marked hepatic and renal damage, which is evidenced by the increase in liver and renal function test parameters in the negative control group. N.sativa extracts prevented this damage. The protective was seen maximum in ethanolic extract followed by the aqueous extract in dosedependent manner. Conclusion: Ethanolic extract showed significant protection against paracetamolinduced and renal damage.

Fetal outcomes in pregnant women with sickle cell disease

To investigate fetal outcomes in pregnant women with sickle cell disease [SCD], and to analyze the impact of baseline variables on those outcomes. This is a retrospective cohort study carried out over 5 years [June 2006 to August 2011] investigating fetal outcomes at Sultan Qaboos University Hospital, Muscat, Oman. Sixty-eight consecutive pregnant women with SCD [62 women with hemoglobin sickle cell anemia [SS] genotype] were included and analyzed in the study. Multivariable logistic regression was used to estimate the impact of baseline variables on major fetal complications [intrauterine growth restriction, intrauterine fetal death, and low birth weight babies, perinatal mortality, and admission to the neonatal unit]. The mean maternal age was 30 years +/- 3.8. Mean gestational age at delivery was 37 weeks +/- 1.8. The initial mean hemoglobin was 9.5 g/dl [standard deviation [SD] 1.1, range 7.2-11.9]. The mean baseline hemoglobin F was 10.2 [SD 6.6, range 0.7-29]. There were 11 cases [16.2%] of intrauterine growth restriction [95% confidence interval [CI]: 7.2-25.2], and 19 cases of fetal distress [27.9%; 95% CI: 17.0-38.9]. Low birth weight was seen in 22 cases [32.4%, 95% CI: 20.9-43.8] with a mean weight of 2.6 Kg [SD: 0.47, range 1.2-3.9]. There were 2 neonatal deaths. On multivariate logistic regression for a composite of fetal outcomes, none of those variables were of statistical significance. The adverse fetal outcomes in pregnant women with SCD are high compared with the general population. There is no significant difference in fetal outcome between SCD, SS genotype versus others

HbA1c levels among primary healthcare patients with type 2 diabetes mellitus in Oman

To investigate whether younger patients with type 2 diabetes mellitus have higher glycated hemoglobin A1c [HbA1c] levels compared to older patients, and to determine the factors associated with higher HbA1c levels. Data from 1,266 patients from all over Oman were used to obtain the mean HbA1c level, odds ratios [OR], and 95% confidence intervals [CI] from multiple logistic regression models with age groups, sex, duration of diabetes, diabetes treatment, body mass index, estimated glomerular filtration rate [eGFR], tobacco use, and healthcare index as predictors of good [HbA1c <7%] vs.poor [>/= 7%] glycemic control. Mean HbA1c levels were 8.9, 8.3, and 7.8 in the age groups 20-39, 40-59 and 60+ years, respectively. After controlling for all other covariates, the OR of good glycemic control increased with age, 40-59 years old [OR=1.7; 95% CI 1.1 to 2.6] and 60+ year [OR=2.5; 95% CI 1.6 to 4.0], female gender [OR=1.5; 95% CI 1.2 to 2.0] and in patients with eGFR >/= 60 mL/min/1.73 m[2] [OR=1.9; 95% CI 1.1 to 3.3]. Longer duration of diabetes [>/= 5years] and treatment with oral agents or insulin were inversely related to good glycemic control. Younger Omani adults exhibit worse glycemic levels compared to older adults posing a formidable challenge to diabetes care teams

Quasispecies of genotype 4 of hepatitis C virus genomes in Saudi patients managed with interferon alfa and ribavirin therapy

Many patients with hepatitis C virus [HCV] infection do not respond to antiviral treatment, possibly due to viral quasispecies. We aimed to investigate whether the quasispeices population could be used as a predictor of response to therapy in our patients. The quasispecies of HCV genotype 4 [HCV-4] were studied in 25 naive Saudi patients at zero, three, and six months following interferon alfa and ribavirin combination therapy. Hypervariable region 1 within the E2/NS1 gene of the virus was analyzed by the single-strand conformation polymorphism [SSCP] technique after amplification. Pretreatment DNA bands by SSCP [2-7 bands] were detected in all patients. In those who achieved a complete virological response within six months [viral load <0.2 Meq/mL; n=7], bands ranged from 2-6 [mean = 3.71 +/- 1.25]. In six of these seven patients, the number of SSCP bands remained either the same or decreased sequentially. In those patients who did not respond [viral load >0.2 Meq/mL; n=18], the bands also ranged from 2-7; mean 3.77 +/- 1.73. In six of these non-responding patients, the SSCP bands remained the same or decreased sequentially. There was no significant difference between pretreatment quasispecies composition and response [P=.53]. Two of the four patients with pretreatment high viral load and the same or decreased composition of quasispecies bands responded to the therapy. Quasispecies in our studied patients cannot be used to predict responsiveness to treatment, but may offer an explanation for failure of most HCV-4 patients to respond to interferon alfa and ribavirin therapy

Pregnancy outcomes of diabetic women: charting Oman's progress towards the goals of the saint vincent declaration

Oman provides comprehensive care for the detection and management of diabetes during pregnancy with the goal of reducing or eliminating adverse outcomes for mothers and newborns. We assessed the outcome of pregnancies complicated with diabetes as compared to healthy controls. A 1-year retrospective review of registry records was conducted on pregnant women with gestational diabetes mellitus [GDM] and pre-gestational diabetes mellitus [PGDM]. Of the 5394 women registered, 225 had GDM and 56 had PGDM. Fourteen cases of GDM and 2 cases of PGDM were excluded. For each patient recruited, the next healthy control of the same age and parity was selected. Nearly 80% of diabetic women achieved good glycemic control [hemoglobin A1c <7%]. Adjusted for hypertension and body mass index, the risk of macrosomia was three times higher among women with GDM [OR=3.03, 95% CI=1.36-6.75] and up to seven times higher among those with PGDM [OR=7.20, 95% CI=2.30-22.61]. A significantly higher risk of cesarean delivery was observed among women with GDM [OR=2.70, 95% CI=1.17-4.03] and PGDM [OR=4.39, 95% CI=1.68-11.49]. Admission to the special care baby unit was higher among infants born to mothers with PGDM [OR=5.70, 95% CI=2.40-13.51] and GDM [OR=2.85, 95% CI=1.68-4.83]. The findings indicate that many of the unfavorable pregnancy outcomes of diabetes for women and infants have not been brought under control despite the comprehensive care provided. Further studies are recommended to evaluate the system of care provided to pregnant women and to identify gaps in achieving the goals of the St. Vincent Declaration

Inhibition of growth of Leishmania donovani promastigotes by newly synthesized 1,3,4-thiadiazole analogs

Leishmania donovani, the causative agent of visceral leishmaniasis, is transmitted by sand flies and replicates intracellularly in their mammalian host cells. The emergence of drug-resistant strains has hampered efforts to control the spread of the disease worldwide. Forty-four 1, 3, 4-thiadiazole derivatives and related compounds were tested in vitro for possible anti-leishmanial activity against the promastigotes of L. donovani. Micromolar concentrations of these agents were used to study the inhibition of multiplication of L. donovani promastigotes. Seven compounds were identified with potential antigrowth agents of the parasite. Compound 4a was the most active at 50 micro M followed by compound 3a. These compounds could prove useful as a future alternative for the control of visceral leishmaniasis

Hurthle cell carcinoma: expanded view

The definition, rarity, and natural history of Hurthel Cell Cancer [HCC] is not well understood, which makes the diagnosis and management of this cancer a controversial issue. The objective of this study is to report a series of patients with HCC and to discuss the clinical behavior along with the prognostic indicators of this disease in an attempt to make more accurate suggestions for treatment. We conducted a retrospective study reporting on all patients with HCC observed at Jordan University Hospital [JUH] and King Abdullah University Hospital [KAUH], during the period from January 2001 to December 2008. Data were collected, analyzed and compared with different results published in the literature. There were 56 Patients with Hurthle Cell Tumor [HCT], diagnosed on fine needle aspiration, of those; 16 were diagnosed as hurthle cell carcinoma by histopathology. All patients with HCC were treated by total thyroidectomy. Postoperatively, all patients with HCC ware treated with radioactive idodine except for 3 patients. Follow-up period for all patients with HCC ranged from 6 to 84 months. No recurrence or distant metastasis were documented during the study period. We could not find higher incidence of local recurrence, distant metastatis or mortality rates compared to literature. HCC seems to have favorable outcome in our part of the world when treated with total thyroidectomy

Anti-inflammatory activities of methanol extracts from various seaweed species.

Thirty-seven species of common seaweeds from the coast of Korea were screened for anti-inflammatory activity Methanol extracts of the seaweeds were tested against mouse ear edema and erythema induced by phorbol myristate acetate. At 40 mg ml(-1) of extract, edema was strongly suppressed by the seaweeds Undaria pinnatifida and Ulva linza, with relative inhibition of 85 and 84%, respectively These two seaweeds also showed the greatest suppression of erythema, with inhibition of 78 and 70%, respectively IC50 values of U. pinnatifida were 10, 15, and 18 mg ml(-1) when inflammation symptoms of edema, erythema, and blood flow, respectively were measured. The IC50 of U. linza was 20, 26, and 31 mg ml(-1) when edema, erythema, and blood flow, respectively, were measured. A linear correlation among inhibition rates of edema, erythema, and blood flow was observed with high confidence.

Study on evaluation of the persistent elevation of C-reactive protein as a predictor of cardiac hypertrophy and dysfunction in elderly patients maintained on hemodialysis

The average age of dialysis patients is increasing each year, reflecting the aging of the population in general. Hemodialysis [HD] patients suffer from a chronic inflammation. They are at increased risk of cardiovascular disease. To evaluate the persistent elevation of C reactive protein [CRP] as a predictor of cardiac hypertrophy and dysfunction in elderly patients maintained on HD. Quantitative determinations of serum high-sensitivity C reactive protein [hs-CRP] by ELISA were done in the 3 studied groups; Group A: included 30 selected end stage renal disease [ESRD] elderly patients maintained on regular HD at the Main Alexandria University Hospitals. Their mean ages were 68.50 +/- 5.20 years [15 males and 15 females]. Group B: included 20 age-matched elderly healthy individuals. Their mean ages were 69.10 +/- 6.42 years [10 males and 10 females]. Group C: included 10 healthy adult individuals. Their mean ages were 34.20 +/- 4.85 years [5 males and 5females]. Doppler Echocardiography was done to all subjects with estimation of ejection fraction [EF%], fractional shortening [FS%], and left ventricular mass index [LVMi] as well as E/A and El/Al ratios. In elderly HD patients, hs-CRP showed statistically significant higher levels than those of groups B and C with significantly higher values in group B than group C [F=19.85, p=0.001]. By using echocardiography, LVMi showed statistically significant higher values in group A than the other 2 groups with no significant difference between them [F=0.854, p=0.01], whereas FS and EF percentages showed no significant differences between the 3 studied groups. Both E/A and El/Al ratios showed statistically significant lower values in group A than groups B and C [x[2]= 13.33 and 12.38, p= 0.00] and 0.02 respectively]. Correlation study showed a significant negative correlation between serum hs-CRP levels and serum albumin, EF% and E/A ratio. On the other hand, serum hs-CRP levels had a significant positive correlation with serum urea, erythrocyte sedimentation rate [ESR] and LVMi. In elderly patients maintained on HD, the persistent elevation of CRP, which reflects chronic inflammation, had a high impact on the occurrence of left ventricular hypertrophy [LVH] and dysfunction. These data lend support to the hypothesis that inflammation plays an important role in the pathogenesis of cardiovascular diseases in these patients